LSBEに発生した同時多発表在癌

Simultaneous Multiple Superficial Adenocarcinomas Arising from Long Segment Barrett's Esophagus, Report of a Case

要旨●患者は50歳代，男性．LSBEとその内部の前壁側に病変を認めた．右壁側や後壁側にも病変を認めていた．治療に関しては，精神発達障害があり，介護する家族は外科的切除を希望せず，また全周切除に伴う狭窄を心配され，内視鏡的に分割切除する方針となった．同時性の3病変を内視鏡的に切除したところ，病変AはpT1a-DMM，リンパ管侵襲陽性であったが，家族の希望で経過観察の方針となった．初回治療から約2年後，異時性に病変が出現し，内視鏡的に切除した．その後の経過は良好で，治療を要する狭窄や多発病変もなく，約10年経過観察することができた．

　A 50-year-old man was found to have LSBE（long-segment Barrett's esophagus）and a lesion on the inside of the anterior wall. Lesions were also detected on the right and posterior walls. He had a mental illness, and hence, the family did not want surgical resection. Moreover, because of a concern regarding stenosis associated with full-circle resection, we decided to perform endoscopic partial resection. We performed the endoscopic resection of three simultaneous lesions; lesion A was T1a-pDMM and positive for lymphatic invasion ; however, the family decided to undergo follow-up. Approximately 2 years after the initial treatment, a metachronous lesion appeared that was endoscopically resected. The subsequent course was good, with no stenosis or multiple lesions requiring treatment, and we intend to follow up with the patient for approximately 10 years.